A Mental Health and Public Safety Primer

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In the grand scheme of the American Psychiatric Association's six-day annual meeting at Washington's massive downtown convention center, one three-hour session inside a subdivided meeting room is small in relative significance and scope.

But in another sense, a gathering of roughly 100 conference participants to talk solely about mental health and public safety as they relate to higher education is notable, given the number of ways to come at issues in the field.

During a session Monday called "The Social Responsibility of Universities for the Mental Health of Students and Community Safety," a panel lined with professors provided an overview of the themes that often appear in this space -- substance abuse, suicide, privacy law, campus violence. The audience appeared quite familiar with the topics. Everyone who identified him or herself before asking a question was associated with academe in one way or another.

Steven S. Sharfstein, chair of the symposium and past president of the APA, said it was the first time that the association featured this type of lengthy discussion about how colleges are dealing with issues of mental health and public safety. He said that since the shootings at Virginia Tech, people in his field from both inside and outside the academy are thirsty for such a session.

"On the whole question of mental health, we wanted to present the different perspectives of students, professors, administrators and clinicians," Sharfstein said.

Several speakers said that campus counseling centers remain overwhelmed and often underfunded, and aren't able to provide the type of services that those in the field would like to see offered.

"The resources are not keeping up," said Jerald Kay, chair of the APA's committee on college mental health and chair of psychology at Wright State University's School of Medicine. "We have a broad variability in terms of the role we play, and it speaks to a major public health need."

The session featured much talk about the often differing interests of students and administrators when it comes to mental health cases. Paul S. Appelbaum, a professor of psychiatry at Columbia University, said it's his impression that student suicides that occur on campus tend to be forever linked to the university in the public consciousness, whereas deaths that take place while the student is home on break don't carry that connection. Colleges are inherently fearful of liability, he said, which helps explain why their policies often favor keeping troubled students away from campus.

Appelbaum said mandatory leave policies for students suffering from mental illness are typically ineffective, because they take the students away from their support system and often their treatment, and can permanently damage self esteem. "It's a sense that 'I've failed, and home can be even more stressful,' " he said.

The threat of suspension can also cause a chilling effect on campus, where students are afraid to share information about their or their friends' mental health. Appelbaum said the safest approach is for colleges not to make blanket policies but to handle students on a case by case basis.

Presenters also noted the challenges administrators face in interpreting federal privacy legislation and case law. Others said that parents and students need to be more involved in discussions about how campuses set their policies on how to deal with troubled students.

Alison Malmon, a University of Pennsylvania graduate who started the nonprofit group Active Minds, which is dedicated to raising awareness of mental health issues on campuses, said she's been astounded how few students either elect to or are asked to participate in formal conversations on campus about mental health.

Malmon said it's important for students to connect with peers who are facing similar mental health problems. Kay said graduate students also need to be part of the conversation. They often have a higher risk of suicide than undergraduates, given that the former students tend to have more demanding academic studies, a less formally structured and supervised environment, and more financial stress.

The public safety conservation largely focused on gun violence. Responding to a suggestion that it's OK for colleges to ban firearms from campus, several people in the audience applauded loudly.

Gary Pavela, director of judicial programs at the University of Maryland at College Park and editor of Synthesis: Law and Policy in Higher Education, said that people in higher education should think about how to create an atmosphere where students and administrators feel like they can talk to one another.

"The lessons aren't about how to put new locks on doors or institute a new whistle system," he said. "One of the main challenges we're facing is that administrators who are fearful of students are disengaging. Everything we've learned says we should be doing the opposite."